Does early repolarization in the athlete have analogies with the Brugada syndrome?

Aim To re-examine the prevalence and presentation of early repolarization i n athletes and to compare it with electrocardiographic abnormalities observ ed in patients with the Brugada syndrome. Methods Electrocardiograms of 155 male athletes and 50 sedentary controls w ere studied. Early repolarization was considered present if at least two ad jacent precordial reads showed elevation of the ST segment greater than or equal to1 mm. Amplitude and morphology of ST elevation, the leads where it was present and the lead in which it showed its maximum value were analysed together with QRS duration, the presence of right ventricular activation d elay, QT and QTc duration. Data were compared with those obtained by electr ocardiograms of 23 patients with the Brugada syndrome. Results Early repolarization was found in 139 athletes (89% and 18 controls (36%, P less than or equal to0.025), being limited to right precordial lea ds in 42 (30%) athletes and 13 (72%) controls (P less than or equal to0.001 ). Only 12 (8.6%) athletes and one control (5.5%) with early repolarization had an ST elevation 'convex toward the top' in right precordial leads, sim ilar to that seen in the Brugada syndrome. In athletes the maximum ST eleva tion was greater (2.3 +/- 0.6 mm) than in the controls (1.2 +/- 0.8 mm; P l ess than or equal to0.004) but significantly lower than in patients with th e Brugada syndrome (4.4 +/- 0.7 mm P less than or equal to0.0001). Patients with the Brugada syndrome also had a greater QRS duration (0.11 +/- 0.02 s ) than athletes (0.090 +/- 0.011 s; P less than or equal to0.0001) with ear ly repolarization. Conclusions Early repolarization is almost always the rule in athletes but it is also frequent in sedentary males. Tracings somewhat simulating the Br ugada syndrome were observed in only 8% of athletes without a history of sy ncope or familial. sudden death. Significant differences exist between athl etes with early repolarization and patients with the Brugada syndrome as re gards the amplitude of ST elevation and QRS duration. (C) 2001 The European Society of Cardiology.